Diagnoses, treatment, and utilization changes in oncology patients before and during COVID-19.
Authors: Miao Wang, Sylvie Lardeux, Elisea Avalos-Reyes, Kjel Andrew Johnson
Journal: Journal of Clinical Oncology (2022)

e18779 Background: COVID-19 has had an unprecedented impact on the healthcare system. During the pandemic, cancer patients experienced delayed diagnoses, interruptions in care and suboptimal care. This study aimed to understand the impact of COVID-19 on breast, lung, colon and prostate cancer patients’ diagnoses, treatment and utilization during the pandemic. Methods: This is a retrospective cohort study of breast, lung, colon and prostate cancer patients insured by a large Commercial and Medicare health plan in the United States. To assess the impact of COVID-19 on newly diagnosed treatment and utilization rates, we compareda pre-COVID period (March 1 to December 31, 2019) to a COVID period (March 1 to December 31, 2020) to assess how COVID-19 impacted diagnoses and treatment. We defined a new cancer diagnosis as a patient with medical insurance but no paid claim for cancer for at least six months before the initial claim with a cancer diagnosis. We utilized both medical and pharmacy claims to identify utilization patterns. The newly diagnosed rate and cancer diagnosis claims were normalized by total membership in the given year by line of business. Results: This study included 113,795 patients in 2019 and 112,837 patients in 2020. The newly diagnosed rate decreased by 4% (2.2 to 2.1 per 1000 patients) (p = 0.0014) for Commercial and 3% (16.2 to 15.8 per 1000 patients) (p &lt; 0.001) for Medicare patients. Patients with infused chemotherapy treatments, among patients with cancer diagnoses, increased by 4% (9.6% to 10%) (p = 0.02) for Medicare patients but not for Commercial patients. Among patients with infused treatments, there were no significant changes in average number of infusions per patient for Commercial and Medicare patients (all p &gt; 0.05). In 2020, there was a 2% decrease in infused treatments in the hospital setting (52% to 50%; p &lt; 0.01) for Medicare patients; it remained stable for Commercial patients. There was also a switch from infused drugs to oral drugs for Commercial (2.4%, p &lt; 0.001) and Medicare patients (2.0%, p &lt; 0.001). From March to May 2020, there was a 31-35% decrease (p &lt; 0.001) in new cancer diagnoses for Commercial and Medicare patients with a rebound in the last six months of 2020. There was an 18-21% decrease (p &lt; 0.001) in the percentage of existing cancer patients with cancer claims during this time, reflecting a decrease in utilization. Conclusions: During the COVID-19 pandemic, we observed significant decreases in cancer diagnoses and utilization rates among new and existing Commercial and Medicare patients; however, chemotherapy treatments increased for Medicare patients during this time. We observed site of care changes in patients undergoing infused treatments. While new cancer diagnoses and utilization rates declined during the pandemic’s height, both rates quickly rebounded in the last months of 2020. As the COVID-19 pandemic continues to evolve, care for patients with cancer will need to evolve as well.